42% of Americans Are Obese. Japan’s Rate is 4.5%. What Can We learn From Them?

In March 2023, Japanese medical authorities announced the approval of Wegovy, a new weight loss drug, amidst a global shortage spurred by high demand. 

This might appear as a victory for Novo Nordisk, the pharmaceutical company behind Wegovy and its sister drug Ozempic. 

However, an analysis from the Pharma Letter suggested a limited impact in Japan due to its notably low obesity rates—just 4.5% compared to 42% in the United States

It seems Japan is the land that doesn’t need Ozempic.

Johann Hari, author of the weight loss drug book Magic Pill, embarked on a journey to understand how Japan maintains such low obesity rates and whether their methods could offer alternatives to the West’s reliance on pharmaceutical interventions. 

Hari’s quest was fueled by a personal and professional dilemma: the balance between the benefits and the risks of using weight loss drugs.

Exploration of Low Obesity in Japan

Hari began by comparing obesity rates globally, quickly realizing that genetics alone do not account for the differences. 

This was illustrated by the health trajectory of Japanese Hawaiians who, despite their genetic closeness to the Japanese, exhibited significantly higher obesity rates after generations in Hawaii. 

This suggested that factors beyond genetics—perhaps environmental or cultural—play a critical role in Japan’s public health success.

Here’s what he found:

1. Dietary Simplicity and Natural Flavors

Japanese cuisine values the intrinsic flavors of ingredients, minimizing the use of excessive fats and sugars. 

This approach not only preserves the natural taste but also keeps meals healthier. In the West, this practice can be adopted by reducing heavy dressings and sauces, opting instead for simple seasoning and letting the main ingredients shine through. 

This would encourage a healthier relationship with food and lower calorie intake.

2. Small Portion Sizes

In Japan, meals typically consist of multiple small dishes, which helps control portion sizes and prevents overeating. 

Western eating habits could benefit from this by incorporating similar practices such as using smaller plates and serving several smaller courses instead of one large plate of food. 

This method can naturally limit caloric intake and help individuals better recognize hunger cues.

3. Triangle Eating Method

The triangle eating method involves consuming different meal components in rotation, rather than finishing each item separately.

 This encourages a balanced intake of flavors and nutrients. Westerners can introduce this method by consciously rotating through a plate of food, such as taking a bite of vegetable, then protein, then starch, which can lead to more balanced meals and improved digestion.

4. Eating Until 80% Full

The concept of “Hara Hachi Bu” — eating until 80% full — is a practice rooted in Japanese eating habits. It allows the stomach to not be overloaded and gives the brain time to register satiety, effectively preventing overeating. 

Western cultures could adopt this mindful eating practice to enhance body awareness and reduce the likelihood of consuming excess calories.

5. Educational Focus in Schools

Japan places a strong emphasis on nutrition education from a young age, with schools employing nutritionists and teaching children about healthy eating habits. 

Western schools can adopt this practice by integrating more comprehensive nutrition education into their curricula and ensuring that school meals are both healthful and appealing to children.

6. Regulatory Measures (Metabo Law)

In Japan, measures like the Metabo Law require adults to maintain a healthy waistline, with interventions available for those who exceed set limits. 

While direct implementation may be challenging in Western contexts, promoting regular health screenings and supporting workplace wellness programs could similarly encourage healthier lifestyles.

7. Cultural Integration of Health Practices

Health practices are deeply embedded in Japanese culture, often supported by public acceptance of government health interventions. 

In the West, creating a culture that values preventive health can be achieved through effective public health campaigns and policies that encourage active living and healthy eating.

8. Communal and Preventive Approaches to Health

Japan emphasizes communal exercises and preventive health measures, promoting vitality into old age. Western societies can implement similar strategies by enhancing community-based health programs and designing public spaces that encourage physical activity. 

This can foster a communal spirit of health and wellness, benefiting the entire population.

Reflections and Global Perspectives

Reflecting on global efforts to combat obesity, Hari noted parallels between Japan’s dietary discipline and past shifts in social norms, such as the reduction in smoking rates in the U.S. 

He highlighted international initiatives like Mexico’s sugary drinks tax and changes in Amsterdam’s school policies as examples of how societal adjustments can influence health outcomes.


Hari concluded that while immediate pharmaceutical solutions like Wegovy offer benefits, the lessons from Japan suggest a more sustainable approach to public health through cultural and policy-driven changes. 

These lessons, if integrated thoughtfully, could help other nations not only manage but prevent obesity, fostering a healthier, more sustainable approach to public health management.


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